Addiction Treatment

New York City residents are still getting arrested for marijuana at the rate of 80 a day, New York state residents face another year without medical marijuana passing, Philly heads for decriminalization of a sort, the Justice Department supports retroactivity for recent sentencing reforms, the Sinaloa cartel has apparently lost another key leader, and more. Let's get to it:

NYC marijuana arrests just keep on coming. (www.nyc.gov)

Marijuana Policy

Colorado Lawsuit Claims Marijuana Taxes Violate Fifth Amendment. Denver attorney Robert Corry Jr. has filed a lawsuit on behalf of an unnamed marijuana retailer arguing that paying pot taxes violates a citizen's Fifth Amendment right against self-incrimination since marijuana remains illegal under federal law. The lawsuit seeks a permanent injunction to stop the state from collecting taxes and the return of all taxes collected. A similar lawsuit has been filed in Washington state by attorney Douglas Hiatt.

New York City Marijuana Arrests So Far This Year at Same Pace as Last Year. New Yorkers are still being arrested for small-time pot possession in high numbers under new Mayor Bill DeBlasio (D). According to the Marijuana Arrest Project, so far this year, NYPD is arresting an average of 80 people a day for pot possession, compared to 78 a day throughout 2013 under then-Mayor Michael Bloomberg (R). Another constant is that blacks and Latinos continue to make up the vast majority of marijuana possession busts. They accounted for 87% of pot arrests last year and 86% so far this year. Click on the title link for more details.

Philadelphia City Council Committee Approves Decriminalization Measure. A city council committee yesterday approved a bill that would make possession of up to 30 grams of marijuana a code violation punishable by a $25 fine -- but would still give police officers the discretion to arrest. But Mayor Michael Nutter opposes the bill. His Public Safety Director, Mike Resnick, said the opposition stems the discretional arrest provision, which he said could create unfair situations. A final vote is likely next week.

Key New York GOP Legislator Says He Will Not Allow Vote on Medical Marijuana. Senate Finance Committee Chairman John DeFrancisco (R) said today he would not allow a vote on the Compassionate Care Act, sponsored by Sen. Diane Savino (D). "The Savino bill will not come out of my committee, the Finance Committee," he said. "You don't have any kind of reasonable research on the effects. You have people coming in here every day trying to ban e-cigarettes and use of tobacco in other ways." He said he and other Senate Republicans may be open to legislation that would not allow marijuana to be smoked. The session ends next Thursday.

Clark County, Nevada, Commissioners Approve 18 Dispensary Licenses. There will soon be 18 medical marijuana dispensaries operating in unincorporated parts of Clark County, the home of Las Vegas. County commissioners approved the licenses yesterday. Nevada approved medical marijuana in 2000, but only approved dispensaries last year.

Drug Testing

Repeated School Drug Tests of Pennsylvania 10-Year-Old Provoke Scorching Editorial. The editorial board at the Pennsylvania news website PennLive has penned a strong editorial condemning the drug testing policy at the Susquenita Middle School, which has resulted in a 10-year-old girl be tested three times so far. The editorial notes that state law requires that school districts actually show there is problem and show that drug testing helps, but that Susquenita has failed to do either. "Repeatedly drug testing a trouble-free 10-year-old student like Natalie Cassell shows how ridiculous this kind of random snooping is. Innocent students are treated like criminals, while drug-using students can dodge the tests simply by deciding not to join after-school activities," PennLive noted. "At a time when school districts across the state are pleading for more state funding, surely Susquenita schools can find a better uses of money than an unproven, highly invasive program that randomly tests innocent 10-year olds.

Sentencing

Justice Department Supports Making Drug Sentence Cuts Retroactive. Attorney General Eric Holder announced Tuesday that the Justice Department is formally supporting a US Sentencing Commission proposal to allow some nonviolent drug offenders currently doing time in federal prisons to seek sentence reductions. The proposal would extend sentencing reforms already approved by the commission by making them retroactive.

Smarter Sentencing Act Gains Four More Sponsors. The Smarter Sentencing Act of 2013 picked up four more cosponsors Monday, three Democrats and one Republican. They are Del. Eleanor Holmes Norton (D-DC), Rep. Kathy Castor (D-FL), Rep. Tony Cardenas (D), and Rep. Paul Ryan (R-WI). The measure now has 37 cosponsors, 24 Democrats and 13 Republicans. It has been sitting in the House Judiciary Committee's Subcommittee on Crime, Terrorism, Homeland Security and Investigations since January.

Prescription Opiates

Massachusetts Governor Unveils Plan to Fight Opiate Use. Gov. Deval Patrick (D) today released a $20 package of proposals to deal with "the opioid addiction epidemic" in his state. He is calling for a summit of regional governors, as well as streamlined access to treatment, better prevention measures, and "strengthening safe prescribing and dispensing practices" to "minimize diversion and misuse." That last bit is likely to raise concerns among people worried about adequate access to prescription opiates. But unlike some other state-level responses to rising levels of opiate use, Patrick's did not contain a law enforcement component. The link leads to the full press release.

International

Key Sinaloa Cartel Figure Reported Dead. Reports are emerging from Mexico that Juan Jose "El Azul" Esparragoza, a key figure in the Sinaloa cartel, has died of natural causes. After the capture of cartel head Joaquin "El Chapo" Guzman by Mexican authorities earlier this year, Esparragoza and Ismael "El Mayo" Zambada were viewed as the effective leaders of the cartel.

Spanish Authorities Close Down Barcelona Cannabis Club for Selling… Cannabis. A Barcelona cannabis club has been closed after police spotted a man approaching tourists and taking them to the club to score. Under Spanish law, one can grow marijuana for personal use, but not sell it. The cannabis clubs have sprung up as a way for consumers to pool their growing resources. Members pay an annual membership fee for a chance to share in the proceeds of the collectively cultivated cannabis, but they're not supposed to sell it.

An Arkansas marijuana legalization initiative can start signature-gathering, DC's medical marijuana program now includes more eligible conditions, Tennessee's governor unveils his prescription drug plan, Canada's mandatory minimum sentencing law is being challenged, and more. Let's get to it:

Group Targets DNC Chair Debbie Wasserman Schultz for Not Voting to End DEA Interference in Medical Marijuana States. The medical marijuana advocacy group Americans for Safe Access is now running TV ads criticizing Rep. Debbie Wasserman Schultz (D-FL), chairwoman of the Democratic National Committee as "out of touch" for voting against a measure to bar the DEA from interfering in medical marijuana states. Wasserman Schultz was one of only 18 Democrats who voted against it while 170 Democrats voted for it. The ads are running on MSNBC in South Florida, where her district is.

DC Medical Marijuana Program Adds New Qualifying Conditions. The DC Department of Health has approved new conditions for which patients will be able to use marijuana. They are seizure disorders, Lou Gehrig's Disease, decompensated cirrhosis, cachexia or wasting syndrome, and Alzheimer's. Hospice patients will also be allowed to use marijuana. Previously, the DC program had been restricted to people suffering from HIV/AIDS, cancer, glaucoma, and muscle spasticity.

Heroin

Ohio Democratic Candidates Call for Tougher Action Against Heroin. Democratic gubernatorial candidate Ed FitzGerald and Democratic attorney general candidate David Pepper are calling for tougher action against heroin. FitzGerald said he wants tougher enforcement on dealers and that rising heroin use should be treated as a public health emergency. And Pepper called for heroin overdose deaths to be treated like murder. FitzGerald added that not enough dealers are going to prison, especially after a sentencing reform bill passed. The Ohio Republican Party responded calling the Democrats "tone deaf" and "ghoulish," saying that Gov. John Kasich (R) has been a strong advocate on the issue, and besides, Attorney General Mike DeWine's (R) office had just indicted two heroin dealers last week.

Prescription Drugs

Tennessee Governor Rolls Out Prescription Drug Plan. Gov. Bill Haslam (R) Tuesday unveiled his seven-point program to battle problems associated with prescription drug use. "Prescription for Success: Statewide Strategies to Prevent and Treat the Prescription Drug Abuse Epidemic in Tennessee" calls for reducing the prescribing of prescription opiates, reducing overdose deaths (including through enactment of a 911 Good Samaritan law), increasing prevention, early intervention, and treatment, and increased cooperation among state agencies and between the state and other entities. While it has a law enforcement component, that doesn't seem to be emphasized. [Ed: There are some good provisions in this document, but reducing the prescribing of pain medications needs to be handled with great care. Although more people are getting opiates now, not all of the people who need them are, and it could easily get even worse for pain patients.]

Drug Testing

California Initiative to Drug Test Doctors Qualifies for Ballot. An initiative that requires random, suspicionless drug and alcohol testing of doctors has qualified for the November 2014 ballot, according to the Secretary of State's office. It also requires doctors to report any other doctor they suspect of being impaired by drugs or alcohol. It also increases the cap on pain and suffering damages in medical malpractice lawsuits, which may the initiative's main goal. Legislative analysts estimate it could cost the state "at least in the low tens of millions of dollars annually" in higher malpractice costs and up to "hundreds of millions of dollars annually" because of changes in the amount and type of health care services provided.

New Zealand Workers Win Drug Testing Case. Workers at a mill who were subjected to mandatory drug tests after two marijuana plants were found growing on the site were treated unfairly and must be compensated, the Employment Relations Authority has ruled. The mill owner had argued that the discovery of pot plants was "reasonable cause" to drug test everybody, but the authority disagreed. "This is a victory for our members, and a victory for common decency and respect," says Ron Angel, a union organizer for timber workers. "Drug testing has to be about proving actual impairment at work - not treating workers as guilty until proven innocent."

Canada Battle over Mandatory Minimum Sentences Heads to BC Appeals Court. A case that could eventually overturn the Conservative government's mandatory minimum sentence scheme for drug offenses is being heard in the BC Court of Appeals today. Earlier this year, a BC provincial court judge ruled unconstitutional an automatic one-year prison term for a person repeatedly convicted of drugs. Lawyers for the government appealed; thus today's hearing. The case is that of Vancouver Downtown Eastside resident Joseph Lloyd, a long-time drug user with 21 previous convictions who was convicted last fall of trafficking small amounts of heroin, cocaine, and meth. The provincial court judge held that mandatory minimum sentences amounted to cruel and unusual punishment.

Bolivian Village to Bake Coca Birthday Cake for UN Head Ban Ki-Moon. UN Secretary General Ban Ki-Moon will be in Bolivia when his birthday rolls around on June 15, and the mayor of Cobija, Ana Lucia Reis, says they are going to bake him a coca birthday cake. "The idea is that Ban tries the coca and realizes that coca is part of our culture and is not cocaine," she said.

A Nevada marijuana legalization initiative picks up a key endorsement, Iowa joins the ranks of the CBD medical marijuana states, Tennessee's governor gets ready to roll out a new plan to address prescription drug use, thousands march for legalization in Santiago, Chile, the Peruvian president backs away from forced coca eradication, and more. Let's get to it:

Coca eradication not too popular in Peruvian towns with coca leaf statues in the main plaza (Phillip Smith)

California Sen. Feinstein Opposes Cutting Federal Funds for Medical Marijuana Raids. Just hours after the US House approved an amendment that would block the Justice Department and the DEA from using taxpayer funds to go after medical marijuana providers in states where it is legal, Sen. Dianne Feinstein (D-CA) said that "if a similar amendment were offered in the Senate, I would strongly oppose it." She said that while she sympathizes with patient needs, "rogue medical marijuana dispensaries, which require little or no medical bona fides and are prevalent throughout California, present major challenges for communities across the country." The 80-year-old politician credited the feds with closing more than 400 "rogue dispensaries" and worried that "the House amendment would prevent these critical enforcement activities from continuing."

Tennessee Governor to Unveil Plan to Address Pain Pills Tomorrow. Gov. Bill Haslam (R) will announce tomorrow a seven-point plan to address rising levels of prescription opiate use. One official said drug treatment will be a key component. In recent years, Tennessee has enacted prescription monitoring legislation and cracked down on doctors accused of over-prescribing opiates. Just last month, a committee of physicians appointed by the health commissioner agreed on new prescribing guidelines that set limits on daily doses doctors can prescribe. The program to be announced tomorrow is supposed to have seven points. Stay tuned.

Law Enforcement

Homicide Charges for Heroin Overdoses Rise in Wisconsin, But…. In a fine example of investigative journalism, the Gannet Wisconsin Investigative Media Team has released an analysis of the increasing use of homicide charges in heroin overdose cases in the state. Under Wisconsin law, anyone who makes, sells, or delivers a controlled substance that leads to an overdose death can by charged with first-degree reckless homicide by drug delivery. The report finds the number of such prosecutions spiking, but that sentences all over the place and the likelihood of being prosecuted depends largely on which county you are in. A good read.

In Warren County, Kentucky, the Drug War Dominates the Court Docket. The latest batch of indictments is out from the Warren County grand jury in Bowling Green, and more than half of them are for drug offenses. Nineteen people were indicted, 11 of them for drug offenses. There were four for possession of meth precursors, three for drug trafficking, two for marijuana trafficking, and one each for meth manufacture and drug possession. There was also one assault, one grand theft, and some drunk driving and "flagrant nonsupport" charges. Drug charges accounted for 58% of all the indictments.

International

Peru President Backs Off on Forced Coca Eradication in the VRAE. In a televised speech Sunday night, Peruvian President Ollanta Humala said he is indefinitely postponing plans to forcibly eradicate coca crops in the valleys of the Apurimac, Ene, and Mantaro Rivers (VRAE). The announcement came just days after Humala fired Carmen Macias as head of the anti-drug agency DEVIDA. Macias had been a strong advocate of a militarized eradication in the region, which produces more than half the country's coca crop and is also home to remnants of the Shining Path. Critics had warned that an aggressive eradication campaign would only help such rebels.

Uruguayan Presidential Candidate Who Vowed to Undo Marijuana Legalization Loses in Primary. "We are going to overturn this law that legalized marijuana growing. Nobody plant anything! Don't plant anything because we're going to knock it down!" National Party presidential nomination favorite Sen. Jorge Larranaga said ahead of Sunday's primary election to see who would get a chance to succeed outgoing President Jose Mujica. But instead, Larranaga lost in a surprise outcome.

Thousands March for Marijuana Legalization in Chile. Thousands of people marched through the streets of Santiago, the Chilean capital, Sunday in support of marijuana legalization. "Don't drive and drive, smoke and fly!" read one sign. Much open marijuana use was reported. Demonstrators demanded decriminalization and legalization, specifically including the right to grow their own.

New Bermuda Premier Says No to Marijuana Legalization, But Leaves Door Open for Decriminalization. Incoming Bermuda Premier Michael Dunkley said last Friday his administration has no plans to legalize marijuana, but could get behind a decriminalization scheme. Dunkley's comments came during a debate on the findings of the Cannabis Reform Collaborative, whose report earlier this month called for medical marijuana, decriminalization, and eventual legalization. "I think it is important to reiterate that the government's public undertaking has related to decriminalization and any potential wider use of cannabis," Dunkerly said. "Let me indicate early in this debate that at this time, the government is not prepared to consider personal cultivation, licenses for commercial cultivation and sale or blanket legalization of cannabis. In so far as this report recommends those things, they do not represent this government's current intentions."

Yann Guignon and Jean-Nicolas Denarie with several varieties of iboga fruit (Sarita Wilkins)

The cover of the conference program guide and report features Esu, a deity in several religions with a multitude of responsibilities, including protecting travelers, roads (particularly crossroads), power over fortune and misfortune, and the personification of death. The illustration was highly apropos -- 52 years after the discovery of ibogaine's interrupting effects on opioid use disorders by Howard Lotsof, the father of the modern ibogaine movement, ibogaine advocates and providers are at an existential crossroads, with serious concerns about sustainability, safety and efficacy.

The last GITA conference was held in October 2012 in the harm reduction heaven of Vancouver, Canada. For this conference, GITA wanted to get back to the medicine's root -- iboga, a rainforest shrub native to West Central Africa that is sacred to practitioners of the Bwiti religion. After years of ibogaine's increasing popularity to treat Westerners with substance use disorders, iboga is under intense ecological pressure, and could be extinct in its native habitat of Gabon by late 2016, according to Yann Guignon, who wrote a report on the status of iboga for the Gabonese government in 2011-2012.

Guignon comes from an unusual background. He was born in France, but has been in Gabon since 2006, when he was initiated in the Dissumba branch of Bwiti. In 2007, France banned iboga after a death that had only an incidental connection to iboga.

Guignon gave the attendees a full report on the parlous state of the plant. "Over 90% of the iboga has disappeared from the country," Guignon said, and what it left is unaffordable -- the price of iboga has risen tenfold in less than decade. A bottle of 300 grams of medium quality root bark costs 100 euros (about $136), in a country where the 30% of the population that is employed has a minimum salary of 120 euros (about $163) per month.

There are also many factors endangering the supply of iboga: increasing land development and urbanization, the growing political and social power of evangelical Christians and climate change. As a result, "fake iboga" is now being marketed as iboga root bark and causing fatalities due to its cardiotoxic effects. And some Bwiti have started using alcohol instead of iboga in their ngenza (practice).

In response to these formidable threats to iboga's future, GITA and Guignon are taking action. GITA has proposed undertaking a collaborative effort with the Ethnobotanical Stewardship Council to launch the Iboga Dialogues, a multi-stakeholder engagement process to develop fair trade and safety standards for global use of iboga and ibogaine. Meanwhile, Guignon and his associate Jean-Nicolas Dénarié have started a few plantations on private land, and are in discussions with the Gabonese government to develop a plantation in one of Gabon's national parks, with the eventual goal of having a plantation in each of Gabon's 13 national parks.

Concerns about safety have been part and parcel of ibogaine's history as a drug detox. It's not just potent psychologically (about 75% of people treated experience intense personal and transpersonal visions -- not hallucinations, as often described in erroneous media reports). On a physiological level, it can produce bradycardia (a slow heartbeat) and/or arrhythmias (irregular heart rhythms). Last year alone, four of the 12 citations for ibogaine on the medical database PubMed were about deaths and toxicity. And rumors of deaths at clinics (as well as sexual assaults and thefts of intellectual property) have served to undermine the disorganized and reputationally disadvantaged ibogaine subculture.

According to Clare Wilkins, Director of Pangea Biomedics, this approach has several advantages over the standard practice of using a flood dose of ibogaine hydrochloride: it uses scarce iboga more efficiently, and allows for treatment of high-risk individuals who are normally excluded from ibogaine treatment. Most importantly, it allows clients to be conscious and gradually integrate the insights they glean about their substance use disorders into their awareness and daily practices.

Safety practices were also discussed by Kenneth Alper, MD, an associate professor of psychiatry at the NYU Langone Medical Center and Jeffrey Kamlet, M.D., FASAM, a Miami Beach-based specialist in addiction medicine, both during the conference and in a post-conference seminar devoted to provider discussion of treatment protocols and practices. Topics included patient electrolyte levels (the "number one problem in treatment" according to Kamlet), treatment of bradycardia and withdrawal from Suboxone, methadone and alcohol prior to treatment.

Thomas Kinsgley Brown, PhD of the University of California, San Diego, reported on the preliminary results of the Mexico study. Data entry for the study was completed in April. According to Dr. Brown, "[i]n the first month, 11 of the [30] participants relapsed, another seven in the second month, one person in the third month, another four in months for through six, one person in the seven month and as many as five went all 12 months without relapsing."

These numbers may not be too impressive -- but as GITA's Development Director Jonathan Dickinson has pointed out, most ibogaine providers are using the drug as a detox, not as an ingredient in a comprehensive treatment plan. Dr. Brown also emphasized that six of the 30 participants had some continuing care in the first few months after ibogaine treatment, and suggested that it might be valuable to compare the ASI (Addiction Severity Index) subscores and/or months to relapse of the participants who received continuing care and those who did not. Factors that Dr. Brown suggested might be determinative of successful ibogaine treatment are a patient's drug use history, age, outlook and expectations of treatment, as well as the integration, type and suitability of fit of any continuing care they receive.

Although in an earlier stage of the study, the results in New Zealand tentatively appear to be promising, according to lead researcher Geoff Noller, PhD and Tanea Paterson, a substance use practitioner/ibogaine provider at Ibogaine Te Wai Pounamu (New Zealand's only current ibogaine treatment provider). The study enrolled its 14th and final subject in April. Seven of the participants were tracked for all 12 months of follow-up (as well as one who was lost to contact at 11 months), and of the six participants still being monitored, three (50%) remain opioid free. Noller and Paterson hypothesized that the differences between the results of the Mexico and the New Zealand studies could be attributed to (among other factors) ibogaine's status as a non-approved prescription medicine in New Zealand, which allows for an integrated system of care between physicians, pharmacists, ibogaine treatment providers and continuing care providers.

"In Durban we saw some important steps on a long road towards uniting the therapeutic and sacramental communities that use ibogaine and iboga. The important factor was outlining a sustainability dialogue that will affect both communities deeply, and I think beyond the practical function of planting trees this dialogue will have an evolutionary impact for everyone involved. What we have seen is that the situation we're facing with iboga's sustainability is grim, but that contained within it is a massive opportunity for cultural dialogue and healing. I believe that here we have been successful in initiating that," said Dickinson.

A conference report is available here. Ibogaine has a long way to go to achieve mainstream acceptance, and potentially safer ibogaine metabolites and analogs, such as noribogaine and 18-MC, are being aggressively developed. But as this conference demonstrated, there is a passionate, committed group of providers and researchers who are working globally to advance the states of the art and science of ibogaine practice.

Yesterday was a bad day for the DEA as the House thrice voted to slap its hands, an anti-marijuana initiative in Montana gets okayed for signature-gathering, the New York Senate releases a report on heroin and opiate addiction and calls for more drug war, marijuana legalization supporters rally in Tel Aviv, and more. Let's get to it:

The DEA had a bad day on Capitol Hill yesterday.

Marijuana Policy

Montana Anti-Marijuana Initiative Approved for Signature-Gathering. An initiative that would repeal Montana's already severely scaled-back medical marijuana law and ban anything listed as a Schedule I controlled substance under the federal Controlled Substances Act, including marijuana, has been approved for signature-gathering. But Billings car dealer and initiative sponsor Steve Zabawa has only three weeks to get the 24,175 signatures necessary to get the measure on the November ballot.

In Historic Vote, House Takes Funds from DEA, Shifts Them to Addressing Rape Kit Backlog. In addition to barring the DEA from going after hemp and medical marijuana in states where they are legal, the House also approved an amendment from Rep. Steven Cohen (D-TN) to take $5 million from the DEA's appropriation and shift the money into grants for state and local law enforcement to address backlogs of untested rape kits. The House voted down another Cohen amendment that would have taken $15 million from the DEA and allocated it instead to the Legal Services Corporation. The House also approved an amendment that would block additional staffing for the Pardon Attorney's Office in a bid to thwart President Obama's call for drug war prisoners to seek clemency.

Colombian Government Releases Outline of Drug Accords With FARC. The Colombian government has released a document laying out the points agreed to with the FARC guerrillas on dealing with drug cultivation and the illicit drug trade. The two sides, meeting at peace talks in Havana a couple of weeks ago, reached the agreement a couple of weeks ago. Colombia Reports has the details at the title link.

Thousands March for Marijuana in Tel Aviv. An estimated 2,000 people marched and rallied for marijuana legalization in Tel Aviv Thursday night. The march comes as the Knesset prepares to debate a bill easing restrictions on medical marijuana next week and a bill from MK Tamar Zandberg to legalize marijuana a few weeks from now.

Colorado has certainly garnered a lot of attention since voters there decided to legalize marijuana in the 2012 election, but when it comes to drug reform, there's a lot more going on in the Rocky Mountain State than just buds, blunts, and bongs. In the past few years, Colorado has taken significant steps toward more enlightened drug policies, and with the powerful coalitions that have emerged to push the agenda, more is likely to come.

Passed last year while all the attention was on the legislature's race to get marijuana commerce regulations passed, the single most significant piece of broader drug reform legislation was Senate Bill 250, which aims to rein in and redirect corrections spending by reducing the number of drug offenders in prison.

The bill creates a separate sentencing system for drug offenders and allows people convicted of some felony drug charges to be sentenced to probation and community-based sentencing and see that felony charge changed to a misdemeanor conviction upon completion of probation. It allow provides that savings from the sentencing changes be plowed back into drug treatment.

The bill didn't come out of nowhere. It was the outgrowth of a 2008 law that created the Colorado Commission on Criminal and Juvenile Justice. That panel brought together in one effort the heads of all the relevant state agencies as they grappled with how to reduce recidivism and put a brake on prison spending. It also provided an opportunity for groups like the Colorado Criminal Justice Reform Coalition (CCJRC) to start confronting the commission with research-based evidence about what does and doesn't work.

"There is a lot of good evidence-based practice that shows what we did in the past didn't work, and a lot of it had to do with national attention," said Pam Clifton, communications coordinator for the CCJRC. "People were asking 'How come half your people are going back to prison?' Well, we didn't have funding for treatment in Colorado. If you didn't have any money, there wasn't any place for you to go. Another problem was helping people on the front end. How can we be more proactive with people on probation? The recession gave us a little bit of leverage."

But to get sentencing and drug reforms passed required not just a commission to come up with best policies and practices, but a political leadership that was willing to act. That came in 2008, when Colorado turned from red to blue, with a new Democratic governor, Bill Ritter, and Democrats in control of the legislature.

"When Bill Owens (R) was governor, he wasn't going to let anything happen," said Clifton. "But with the commission, a lot of conversations got started and we were able to educate about why change was needed, so when we had a change in leadership, there was a mandate from the commission to get good legislation passed. A lot of the recommendations the commission made went directly to the legislature, and when a bill showed up from the commission, it had a better opportunity to survive the process."

And while, as noted above, the legislature has passed other reforms, Senate Bill 250 was the biggie.

"That was the landmark legislation that really changes things," said Clifton. "This was the whole state -- prosecutors, defense counsel, the commission, us -- coming together and agreeing it was the right approach."

The bill only went into effect last October, so its results remain to be seen. But advocates are confident it has not only changed the conversation about drugs and sentencing, but that it will pay off in terms of fewer prisoners doing less time at less cost to the state -- and with less harm to the futures of drug offenders in the state.

Even the prisons are scenic in Colorado, although it is hoped that fewer prisoners will be forced to enjoy the view soon. (CDOC)

"It's too early to tell what impact Senate Bill 250 will have," said Art Way, Colorado manager for the Drug Policy Alliance. "It was definitely a step in the right direction, though. It shrank the number of felony degrees for drug charges from six to four, and now, many low-level drug felonies can wobble down to misdemeanors thanks to that bill. It's not true defelonization of use and possession, but it still gives defendants some opportunities to avoid the label of felons."

And the CCJRC deserves some major credit, he said.

"The CCJRC has been doing great work in the past decade revealing that we are on an unsustainable path," said Way. "The Department of Corrections budget was only increasing year after year, and they were able to make this a fiscal argument as well as a human argument. They've been at the forefront here."

Another front where Colorado is forging ahead is harm reduction. Needle exchange programs were legalized in 2010 and there are now six across the state, the state passed a 911 Good Samaritan law in 2012, and a law allowing friends and family members of injection drug users to carry and administer the overdose reversal drug naloxone (Narcan) passed last year.

Activists have also managed to push through laws exempting needle exchange participants from the state's drug paraphernalia laws, and in Denver, an ordinance last year allowed the first mobile needle exchange in the state.

"We've been really excited, not only about all these programs, but also about getting these policy wins," said Lisa Raville of the Denver-based Harm Reduction Action Center. "Every time we go to the capitol, we've been winning. The legislature is very excited about harm reduction."

After passing Senate Bill 250, this year was relatively quiet on the sentencing and drug reform front. There are a number of reasons for that, some of them having to do with gauging public (and legislative) attitudes in the wake of a well-publicized violent crime, the killing of state prison chief Tom Clements by a parolee.

"Our corrections director was murdered last spring, and that caused a lot of ripples and made people at the capitol freak out a bit, so we wanted to tread lightly," said Clifton. "And things are really tricky in Colorado now," she added. "Elections are coming up, and everyone's concerned about what color we're going to be come November. Our elected officials are all being very cautious right now."

Like the CCJC, the harm reductionists were quiet in the legislature this year. It was a time for solidifying gains and getting previous victories implemented, Raville said.

Harm reduction measures in place in Colorado include needle exchanges and overdose reversal drug access. (wikimedia.org)

"This is an election year, and we knew they would be playing defense at the capitol," she said. "We decided this year would be all about promoting harm reduction policies and procedures. When we got those laws passed, we assumed that the legislature and the courts would implement them, but they didn't, so we spent the first six months promoting implementation, working with the legislature, as well as working with doctors and pharmacies so they know about these new laws."

But that doesn't mean the Harm Reduction Action Center is giving up on the legislature.

"Depending on how the election goes, our goal next year is total syringe decriminalization," said Raville. "We have the exemption for needle exchange participants, but there are still folks who won't ever access a needle exchange program, and we want them exempt as well. Now, you can get eight to 15 days in jail for every syringe, clean or used."

"Robert Childs and the NCHRC got that passed with the support of law enforcement, who didn't want to get pricked," she said. "That's inspired us to work closely with the Denver Police Department. We have two officers on our advisory board."

"We have an overdose issue here in Colorado," Raville noted. "ODs have tripled in the past 10 years, and we have a fatal overdose every day and a half in the state. Not many doctors are prescribing naloxone, but we've had 92 overdose reversals so far. And a couple of hospitals in Denver are discharging overdose patients with a prescription for naloxone. We're trying to make that the standard for hospitals across the state."

While it was relatively quiet this year in the legislature, activists had to play defense on one set of bills and managed to kill them. That was a pair of bills to amend the civil code for child neglect to explicitly include marijuana use as an indicator, even though the state has legalized both medical and recreational marijuana use and possession.

"Stopping that bill was our top concern this year," said Way. "We worried that amending the civil code the way those bills tried to do would simply help law enforcement during drug investigations by leveraging parental rights. This wasn't a public health approach; it was a law enforcement bill couched as a public health and child protection bill," he said.

"The bill's fiscal notes only involving increasing bed space for what they expected to an influx of people put in jail," he noted. "There was nothing about access to treatment or reunification with kids. It was a standard, punitive drug war approach to a public health issue, and we were able to kill it for the second year in a row."

"We've convened a stakeholder group from around the state -- health care and criminal justice people -- to make sure they knew each other as a step toward successfully implementing the ACA, getting more people in treatment, and reducing the prison population. We're teaching people how to navigate the system and teaching the system how to help people navigate it," she said.

And while sentencing reform and harm reduction efforts in Colorado haven't, for the most part, been about marijuana, the whole opening on marijuana has given political and social space to drug reform efforts that go beyond pot.

"The conversation about marijuana has absolutely helped," said Raville. "We legalized it and the sky didn't fall. This has helped normalize pot and normalize drug use more broadly. And it's been a good opportunity to talk to people about how voting matters."

"Marijuana reform has helped legislators understand what we mean by a public health approach," said Way. "We hope to now be able to address drug policy on a broader level with the legislature."

But much of that will depend on what the makeup of the legislature looks like after November. Still, Colorado has shown what some persistence, some coalition-building, and some science, evidence, and compassion can accomplish.

A new poll suggests Vermont is ready to legalize it, and so is the mayor of Rome, a San Francisco crack pipe exchange is set to expand, a West Virginia county's latest grand jury indictments shine a light on drug war in the Appalachians, Bermuda marijuana growers want an emergency exemption for medical marijuana, and more. Let's get to it:

Bermuda-grown cannabis indica await patients there. (Alan Gordon)

Marijuana Policy

Vermont Poll Has 57% Support for Legalization, Taxation, and Regulation. A new poll from the Castleton Polling Institute has 57% of respondents saying they would support legalizing marijuana for adults, taxing it, and regulating it like alcohol. Only 34% were opposed. The poll has +/- 4% margin of error. The Vermont legislature approved a bill in April that includes an amendment initiating a study to evaluate the potential impact of making marijuana legal for adults and regulating it similarly to alcohol. Gov. Peter Shumlin (D) is expected to sign it into law.

Medical Marijuana

North Carolina Legislator Files Bill for Medical Marijuana Referendum. Rep. Kelly Alexander (D-Mecklenburg) has filed a measure, House Bill 1161, that, if approved, would put a referendum on the November ballot asking voters to legalize the use and cultivation of marijuana to treat specified medical conditions. Alexander had filed a medical marijuana bill last year, but it went nowhere in the legislature. The new bill would have to get super-majorities in both chambers of the legislature before it could go to the voters.

Harm Reduction

San Francisco's Crack Pipe Exchange Program to Expand. A crack pipe exchange program operated by volunteers from the Urban Survivors Union, a drug users' rights group, is set to expand even though the city won't condone or fund the program. Volunteers have been distributing about 50 clean crack pipes a week in the Tenderloin, SOMA, and Polk Gulch neighborhoods, even though city officials say there is no evidence it is an effective harm reduction measure. Seattle is the only other city in the country with a similar program.

Sentencing

Federal Smarter Sentencing Act Picks Up Another Sponsor. Rep. David Price (D-NC) has become the latest representative to endorse the Smarter Sentencing Act of 2013 (House Resolution 3382). The bill would reduce some drug mandatory minimums, allow judges greater leeway to sentence beneath the mandatory minimum, and allow for reduced sentences for crack offenders whose offense took place before passage of the Fair Sentencing Act of 2010. Price is the 32nd cosponsor and the second this week.

Law Enforcement

In One West Virginia County, Drugs Dominate Grand Jury Indictments. Holy hydrocodone, Batman! The Fayette County grand jury in West Virginia has just released its May batch of bills of indictment, and 71 out 101 of them were for drugs and related charges. There are a whole lot of "conspiracy" and "possession with intent to distribute" charges, too. The indictments don't specify which drugs were at play, but there are a bunch of "obtaining a controlled substance by misrepresentation, fraud, or forgery" charges as well, and a handful of meth lab charges. Click on the link for the whole list.

International

Mayor of Rome Says Legalize It. Rome Mayor Ignazio Marino said Wednesday he supports legalizing marijuana in Italy. "I am in favor of the possibility of deregulating cannabis for medical or personal use," he told the 8th Annual Conference of the International Society for the Study of Drug Policy. "In 2011, more than one million plants were confiscated in our country compared to 73,000 in France," Marino continued. "Organized crime still manages large portions of international traffic and there are enough reasons to reopen the debate today in Italy. We live in a time in which reform for drug laws is necessary on an international and national level. For Italy I personally have a very clear idea of what needs to be done: the decriminalization of marijuana should be considered a starting point because the years of prohibition have not brought any results to prevent the dramatic increase in the use of drugs. In addition, new forms of legalization could be experimented with in medicine for people's health but also to target organized crime." Marino's comments come just weeks after the Italian parliament approved a new law amending the country's drug laws and treating marijuana as a "soft drug" with reduced penalties.

Portugal Soon to Get First Safe Injection Site. The Lisbon city council has approved the location for what would be Portugal's first "assisted consumption room" for drug users. Portugal approved safe injection sites several years ago, but left implementation up to local councils. None had moved to do so until now.

Bermuda Marijuana Growers Seek Emergency Amnesty for Medical Grows, Offer Up Over 50 Locally Available Varieties. Bermuda attorney and marijuana reform activist Alan Gordon, speaking on behalf of a collective of nearly two dozen Bermuda marijuana growers, called today for the government to act immediately to allow for the use of medical marijuana, as called for in last month's Cannabis Reform Collaboration report. "There is only one way to allow the immediate medical cannabis called for by the CRC Report," Gordon said. "We need to just do it instead of just shuffling paperwork. Eighty small medical grade cannabis trees are available to start, and over 50 medical cannabis strains currently on-island." Click on the title link to read more.

Indonesia's New Drug Treatment Over Prison Scheme Faces Challenges. In another excellent analysis from Asiancorrespondent.com, Patrick Tibke looks at Indonesia's progressive new guidelines for the "Processing of Drug Addicts and Drug Abusers into Rehabilitation Centers" and warns of the obstacles ahead in actually implementing such reforms. As he notes, the move was not new legislation, but simply gives a push to the country's 2009 Narcotics Law, which first allowed for the rehabilitation of drug users instead of their incarceration. Whether and how this will actually be implemented remains to be seen. It's a good, thorough read; click on the link for the whole thing.

A bill that would significantly reform California's drug sentencing laws is poised for approval in the state Senate, and a new poll showing strong support for sentencing reform among Latino voters could help push it over the top.

California's prisons are still overcrowded. (supremecourt.gov)

Senate Bill 1010, the Fair Sentencing Act, would equalize the penalties for sale of crack and powder cocaine. Under current California law, crack offenses are treated more harshly than powder cocaine offenses. The bill would also equalize probation requirements and asset forfeiture rules for offenses involving the two forms of the same drug.

Sponsored by Sen. Holly Mitchell (D-Los Angeles), the bill passed the Senate Public Safety Committee last month and the Senate Appropriations Committee last week. It now heads for the Senate floor. It needs to pass in its chamber of origin this month or it dies.

The bill is supported by dozens of community, religious, civil liberty, civil rights, drug reform, and other groups. It is opposed by the California Narcotics Officers Association and the California Police Chiefs Association.

Among Latino groups supporting the bill are the National Council of La Raza, the Coalition for Humane Immigrant Rights, Homies Unidos, the Latino Voters League, the Mexican American Legal Defense and Education Fund (MALDEF), and Presente.

The poll results released today by Latino Decisions help explain why these groups are supporting sentencing reform efforts and may even encourage them to redouble their efforts. They show strong support for sentencing reform among California's Latino electorate. The poll only sampled registered voters.

When asked if the state should minimize penalties for drug possession, but continue to hold drug sellers accountable, a whopping 69% said yes. The lowest level of support among any Hispanic demographic was 59% among 40-to-59-year-olds.

When asked if racial disparities in law enforcement were a serious or very serious problem, an even more overwhelming 82% said yes. Even among Latino Republicans, the demographic least likely to be concerned, the figure was at 57%.

"We're very excited to see the results of this poll," said Arturo Carmona, executive director of Presente, during a teleconference announcing and analyzing the results. "It's very clear that the poll findings reaffirm that Latinos want drug sentencing reform and a fix to our broken justice system. If politicians want to mobilize the Latino vote, they need to support these issues. Over the coming weeks and months, Latinos and allied groups will be working to support common sense reforms like this bill."

That only makes sense, Carmona said.

another drug arrest in California. (wikimedia.org)

"These issues are having a significant impact on our society, our state, and increasingly, the Latino community," he argued. "The US imprisons more people than any nation in the world, mostly due to the war on drugs, and blacks and Latinos are far more likely to be criminalized than whites. When you add in the federal detention center population, Latinos now make up the largest federal prison population in the country."

Dr. Adrian Pantoja, a senior analyst with Latino Decisions, emphasized that the poll was of registered Latino voters.

"These are folks who are part of the political process," he said. "These are the Latinos who will be voting and helping to shape our politics. And among them, we have a rejection of war on drugs strategies and incarceration, with large majorities across the board supporting sentencing reform for drug possession and use."

"It's evident that the Latino community is in a state of crisis," said Armando Gudino, a policy associate with the Drug Policy Alliance. "This is the community most disproportionately impacted by the war on drugs and unprecedented levels of incarceration. Latinos are fully aware of this, and we've begun to shift toward more responsible policies seeking to remove or reduce criminal penalties."

The poll demonstrates that attitudes are changing in the Hispanic community, Gudino said.

"Latinos have traditionally been deemed a conservative group, but we see shifting attitudes, and we could well see support we haven't seen in the past," he noted. "The older generation is more conservative, but the community isn't homogenous, and the same can't be said about other groups within the community, who have already shifted toward favoring issues like decriminalization, medical marijuana, and the efforts around taxing and regulating marijuana. This poll demonstrates that the Latino community is increasingly involved, informed, and willing to make changes."

"Latinos are now a majority in California, we have a seat at the table, and it's critical we're part of this conversation," said Mike De La Rocha, director of strategic partnerships for Californians for Safety and Justice. "Latinos are poised to have a voice in how we address crime and public safety. We understand our approach to crime isn't working, and we're finding our voice in these criminal justice debates."

The NFL is about to adopt a more sensible marijuana policy, the DEA will unblock imported hemp seeds so Kentucky can do some research, Minnesota legislators try to reach a compromise on medical marijuana, the rate of prescription overdose deaths is up, and more. Let's get to it:

People are dying of prescription drug overdoses at a rate three times that of a decade ago, says the CDC. (wikimedia.org

NFL Reportedly Will Cut Marijuana Punishments. ESPN.com is reporting that when the NFL's new player drug policy is announced, punishments handed out for marijuana use will be reduced. ESPN also reported that the new drug policy will have a higher threshold for the amount of marijuana needed to trigger a positive test result. At least one current NFL player, Cleveland Browns receiver Josh Gordon, is facing a season-long suspension for running afoul of the league's marijuana policy. The NFL Players Association had suggested the league review its policy on marijuana and drug testing in general.

DEA Will Allow Hemp Seeds to Enter US for Kentucky Research Project. Kentucky Agriculture Commissioner James Comer said Tuesday that the DEA will quit trying to block the import of Italian hemp seeds to Kentucky for research purposes now permitted under the hemp amendment to the recently passed omnibus farm bill. The seeds are being held by US Customs at a warehouse in Louisville. Cromer was ready to go to federal court today, if the DEA had not yielded. The state Agriculture Department and several universities are planning hemp research projects this year, but they need to get the seeds in the ground. The clock is ticking.

Drug Treatment

Massachusetts Drug Treatment Bill Being Debated Today. A bill that would ease access to drug treatment, by forcing insurance companies to cover treatment that's provided without prior authorization from them, is being heard in the state Senate today. The measure is Senate Bill 2133, which was developed by a special legislative committee on drug addiction. There are 37 amendments to get through, too.

No Safe Injection Rooms for Brighton after UK Government Warns Health Workers of Risk of Arrest. Last year, the Independent Drugs Commission for Brighton and Hove suggested that Brighton and Hove establish drug consumption rooms, saying they could take drug use off the streets and reduce overdose deaths. But those plans have now been shelved after the Home Office warned that health workers working in such facilities might be subject to arrest. The idea also got a mixed reception from the public.

Jamaica Marijuana Conference Coming Later This Month. The inaugural Jamaica Cannabis Conference is set for May 22-24 at the University of the West Indies campus in Mona. The theme is "Wake Up, Jamaica; Our Opportunities Are Slipping Away." Click on the link for more details.

Jamaican Musician and Poet Mutabaruka Tells Gambia to Legalize It. On a visit to Gambia to perform at the 11th annual International Roots Homecoming Festival, famed Jamaican poet and reggae singer Mutabaruka said Tuesday that Gambia should legalize marijuana and that "no youth should be in trouble over marijuana," citing the international movement toward marijuana legalization.

(This article was published by StoptheDrugWar.org's lobbying arm, the Drug Reform Coordination Network, which also shares the cost of maintaining this web site. DRCNet Foundation takes no positions on candidates for public office, in compliance with section 501(c)(3) of the Internal Revenue Code, and does not pay for reporting that could be interpreted or misinterpreted as doing so.)

When -- despite the objections of medical groups, reproductive health advocates, and even the drug czar's office -- Tennessee Gov. Bill Haslam (R) signed into law Senate Bill 1391 late last month, the Volunteer State became the first in the nation to pass a law criminalizing pregnancy outcomes. Other states, such as Alabama and South Carolina, have used fetal harm laws to charge drug-using pregnant women, but Tennessee is the first to explicitly criminalize drug use during pregnancy.

Passed in the midst of rising concern over prescription drug and heroin abuse and aimed, its proponents said, at protecting babies, the law allows women to be criminally charged with an "assaultive offense for the illegal use of a narcotic drug while pregnant, if her child is born addicted to or harmed by the narcotic drug or for criminal homicide if her child dies as a result of her illegal use of a narcotic drug taken while pregnant."

Felony assault can earn you up to 15 years in prison in Tennessee. And while some prosecutors have said they will only file misdemeanor charges, that's not written into the law.

Proponents cited recent reports that the number of babies being born addicted to drugs is on the rise. Such infants are diagnosed as having Neonatal Abstinence Syndrome, or withdrawal symptoms after being exposed to opiates in the womb.

"Over the past decade, we have seen a nearly ten-fold rise in the incidence of babies born with NAS in Tennessee," the state Department of Health reported. Infants with NAS stay in the hospital longer than other babies and they may have serious medical and social problems."

But the state Health Department notwithstanding, experts in the field say that NAS doesn't actually have long-term effects, it's not accurate to call newborn infants "addicted," and that misrepresenting matters by vilifying pregnant women isn't helpful. In fact, more than 40 of them said so in an open letter last month.

More generally, leading medical groups, including the American Medical Association, the American Nurses Association, the American Academy of Pediatrics, and the American Public Health Association reject the prosecution and punishment of pregnant women who use drugs. The groups mentioned above and many others said so in this 2011 document.

A coalition of medical, public health, women's rights, and social justice groups worked to oppose the bill as it made its way through the legislature, and then to convince Gov. Haslam to kill it. A petition with over 11,000 signatures urging him to veto the bill went to his office late last month. More than two dozen organizations devoted to ensuring families have access to health care likewise urged a veto, as did the American Association of Pediatrics, the National Perinatal Association, and International Doctors for Healthier Drug Policy.

Even acting drug czar Michael Botticelli raised a warning flag.

"Under the Obama administration, we've really tried to reframe drug policy not as a crime but as a public health-related issue, and that our response on the national level is that we not criminalize addiction," he said during a visit to Nashville as the governor pondered. "We want to make sure our response and our national strategy is based on the fact that addiction is a disease. What's important is that we create environments where we're really diminishing the stigma and the barriers, particularly for pregnant women, who often have a lot of shame and guilt about their substance abuse disorders."

But none of that mattered. On April 29, Haslam signed the bill into law.

"In reviewing this bill, I have had extensive conversations with experts including substance abuse, mental health, health and law enforcement officials," Haslam said in a statement. "The intent of this bill is to give law enforcement and district attorneys a tool to address illicit drug use among pregnant women through treatment programs."

"Today, the Tennessee governor has made it a crime to carry a pregnancy to term if you struggle with addiction or substance abuse," Alexa Kolbi-Molinas, staff attorney with the ACLU Reproductive Freedom Project, said in a statement in response to the signing. "This deeply misguided law will force those women who need health care the most into the shadows. Pregnant women with addictions need better access to health care, not jail time."

"We are very sorry to see that Governor Haslam let an opportunity to do the right thing slip through his fingers," said Rebecca Terrell, the group's chairwoman."The experts could not have been clearer: this law is bad for babies and bad for Tennessee."

"This law says that women are to be held criminally accountable for the outcomes of their pregnancies," said Farah Diaz-Tello, a staff attorney with National Advocates for Pregnant Women, which was part of the coalition fighting the new law. "It essentially creates a system of separate and unequal rights. Drug ingestion is not a crime in Tennessee, just possession, and now, only pregnant women are criminalized for ingesting. They can be surveilled and punished by the state in ways different from other people. The law also treats fertilized eggs or fetuses as if they were people independent of the pregnant woman," she told the Chronicle.

Gov. Bill Haslam (tn.gov)

"It's the wrong response to the problem of addiction," said Diaz-Tello. "It's a health problem that is not responsive to threats and punishment. What kind of society do we want to be? Do we want to punish the people most in need of help and support? These are women largely living in poverty, women of color, who are already made vulnerable by our social policies, and now we hold them solely responsible without looking at society and what else is going on leading to pregnancy among addicted people and this horrible punitive response."

Even framing the issue as "pregnant women taking drugs" is somewhat misleading, said Diaz-Tello.

"We often make the mistake of thinking of people using drugs during pregnancy as pregnant women who became addicted to drugs when it should be the other way around," she said. "The reasons for addiction are complex and often gender-based. Women who have experienced violence and trauma are often self-medicating, and there is a lot of unresolved pain and trauma out there. And half the pregnancies in our country are unintended, which disproportionately affects women on the margins. It's not like someone wakes up pregnant one day and decides they want to do drugs."

The law will not operate in a vacuum. Tennessee is one of those states that has refused to expand Medicaid and has rejected the Affordable Care Act. It is more difficult for poor women there to get access to health care services, including drug treatment, but now it will be easier to prosecute them.

"This is definitely for the most part going to affect poor, marginalized, predominantly rural women," said Cherisse Scott, founder of SisterReach, a Memphis-based group working for reproductive justice for women and girls in the city and the Mid-South area. "That's because of the many barriers they face. Many rural areas just don't have the facilities to offer help to these women."

Scott also bemoaned the criminalization of pregnant women who use drugs under the law, a process of stigmatization and punishment only made more severe for women lacking resources.

"Low income women, women of color, already have issues navigating the court system, and many don't have any kind of support system," she said. "When their children are taken, they don't have the resources to get them back. And the other piece of this is that jails aren't hospitals or treatment centers. They don't offer women an opportunity to be properly rehabilitated from drug use."

And then there's the aftermath of a criminal conviction.

"If you look at this through the lens of racial and reproductive justice, how does a woman with this on her record bounce back, how does she get a job? With a criminal background, she will be further locked out," said Scott. "These are the kinds of barriers and issues that will ultimately hurt the mothers of Tennessee. We can't support legislation that uses criminalization as a means of rehabilitating people," she told the Chronicle.

"Our lawmakers had good intentions, but they didn't think it through," said Scott. "They seem to be very ready to separate mothers and children as a way of helping, and we don't see it like that, especially when there are rehab programs that keep mother and children together."

The new law is also generating alarm with advocates for people who use opioid maintenance therapy to deal with opiate addictions. Methadone and buprenorphine maintenance are the gold standard for treating pregnant women addicted to narcotics. While state health officials have said they interpret the law to mean that a pregnant woman on methadone maintenance would not be in violation of it, there is no language in it that explicitly says that.

"I asked the governor to veto the bill because that exclusion wasn't made," said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence. "The real question is whether some representative for the attorney general's office or a DA or child protection services interprets it that way. This is a potential problem. When you're talking about child protection, it's not unusual for a judge or child protection worker to say to a pregnant mom 'You can't be on methadone.' I hope this law will not be used as a method of forcing maintained patients out of care."

While babies born to opiate-addicted women can suffer from Neonatal Abstinence Syndrome, or withdrawals, they can be treated for that, mainly by slowly tapering the dose of opiates. But, Parrino said, not all pregnant mothers on methadone maintenance have babies with the syndrome, and consequences for fetuses can be serious if mothers are forced off opiates during their pregnancies.

"What happens to a fetus if you force mom to end her medication?" he asked. "In the first trimester, a sudden decrease can be harmful to the fetus. There could be spontaneous abortion. It's in the literature. That's why laws like this raise concerns in people who have some knowledge about how pregnant women are treated."

Parrino, too, saw race a playing a role, but in an unexpected way.

"What I am seeing for the first time in 30 years is a real interest by elected officials, many US senators and governors and legislators, who can't wrap their heads around why white teens and 20-somethings from middle class families in the suburbs and rural areas are shooting heroin," Parrino observed. "Those elected officials are right to be worried. This legislation in Tennessee is a result of those dynamics."

While the law may have been passed with the best motives, "the problem is the criminalization aspect," said Parrino. "Even if it can be explained as having a reasonably good intention of getting pregnant women not to use drugs and go to treatment, you are unwittingly subverting that goal by saying that being in methadone maintenance might be seen as not complete treatment. That uncertainty is creating anxiety."

The new law is set to go into effect on July 1, but efforts are already underway to block it and, barring that, to mitigate its effects.

"We're still trying to figure out the best plan of action," Scott said. "We want to figure out the best way to support women who are going to be victims of this policy. At the grass roots level, that means education, awareness, getting the word out through rehab centers to let the women know this is coming. Then we have to figure out what is the legal strategy to try to change this law. We're working on it."

"We're thinking about a legal challenge, especially on constitutional grounds," said Diaz-Tello. "We have worked with public defenders in Tennessee and other states on challenging similar laws on constitutional grounds. There's also the possibility of an affirmative suit to get the law enjoined. It would be ideal to stop this law before anyone gets arrested under it."

Barring the successful blocking of the law, drug-addicted pregnant women in Tennessee will face the tender mercies of the criminal justice system. But not all of them, of course.

"Race and class plays a role as always," said Scott. "Poor mothers go to jail; mothers with access to more resources may not be penalized at all. Women who have access to health care and can afford private prenatal care and treatment will get treatment; women who have no alternative but public aid or a public health clinic will be disproportionately impacted as always. Nothing's changed as far as race and class."